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Bilan électrophysiologique d’un syndrome du canal lombaire étroit

Electrodiagnosis of lumbar spinal stenosis

  • Mise Au Point / Update
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Pelvi-périnéologie

Résumé

Le syndrome du canal lombaire étroit (ou rétréci) est une pathologie fréquente du sujet âgé. Le diagnostic est basé essentiellement sur l’interrogatoire (troubles sensitifs des membres inférieurs survenant à la marche) et l’examen clinique. L’imagerie lombaire (scanner et imagerie par résonance magnétique) permet de confirmer l’existence du rétrécissement canalaire et d’en déterminer la sévérité et l’étendue, mais n’est pas spécifique de son caractère symptomatique sur le plan clinique. L’exploration électrophysiologique est complémentaire à l’imagerie, puisqu’elle évalue l’aspect fonctionnel plutôt qu’anatomique de la maladie. L’examen électroneuromyographique comprend l’étude de l’activité électromyographique à l’aiguille et l’étude des conductions nerveuses sensitives et motrices, y compris les ondes tardives H, T, et F. Ces techniques permettent de différencier une atteinte radiculaire, plexique ou tronculaire. L’étude des potentiels évoqués somesthésiques et moteurs permet de mettre en évidence l’existence d’une atteinte des voies longues de la moelle concomitante. L’exploration électrophysiologique du périnée permet d’étudier le retentissement de la pathologie sur les dernières racines sacrées. Le fait de combiner ces différentes techniques a pour intérêt d’augmenter la rentabilité diagnostique de l’examen électrophysiologique et de mieux connaître le niveau et les mécanismes lésionnels en cause. Dans ce texte sont discutées l’utilité et les limites des différentes techniques électrophysiologiques applicables dans l’exploration d’un syndrome du canal lombaire étroit.

Abstract

Lumbar spinal stenosis is a frequent source of morbidity in the elderly. The diagnosis is primarily established on a clinical basis. Spine imaging confirms stenosis and determines its severity and extent, but does not differentiate symptomatic from asymptomatic forms. Clinical neurophysiology is complementary to imaging, addressing the functional rather than structural aspects of the disease. Electrophysiological tests include needle electromyography and nerve conduction studies with H-reflex, T-reflex, and F-wave recordings. These techniques differentiate nerve root from plexus or nerve trunk lesions. Somatosensory and motor evoked potentials can reveal concomitant spinal tract injury, and perineal neurophysiological testing more specifically assesses the involvement of S2 to S4 roots. The application of a battery of techniques is able to increase the diagnostic yield of electrophysiological studies and to better appraise the anatomical level and underlying mechanisms of the lesions. In this text, the value and limitations of these techniques are discussed in addition to the typical findings obtained and their pathophysiological significance.

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Authors and Affiliations

  1. Service de physiologie, explorations fonctionnelles, hôpital Henri-Mondor, 51, avenue de Lattre-de-Tassigny, F-94010, Créteil cedex, France

    R. Ahdab & J.-P. Lefaucheur

  2. EA 4391, université Paris-est, Créteil, France

    R. Ahdab & J.-P. Lefaucheur

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  2. J.-P. Lefaucheur
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Correspondence to J.-P. Lefaucheur.

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Ahdab, R., Lefaucheur, JP. Bilan électrophysiologique d’un syndrome du canal lombaire étroit. Pelv Perineol 5, 155–163 (2010). https://doi.org/10.1007/s11608-010-0339-5

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